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I
FORM 1037
REV. JULY 1941
AMERICAN RED CROSS
NURSING SERVICE
Date
APPLICATION FOR ENROLLMENT
(To be filled out in applicant's handwriting and each question
1. Name of applicant in full mounth Thaum
J.
If married, give maiden name
Farest Ruth gutheri
E,
2. Permanent address
R. R# / Custlins Crawford ahio
3. Probable address for one year 286 Cleveland ava "ashland (ashland (County) ahio (State)
(Street)
(City)
(Street)
(City)
(County)
(State)
4. Name and permanent address of nearest relative or friend residing in the United States:
John R Laum Crestline O
Husband
(Name)
(Address)
(Relationship)
5. Race
6. Present Marital Status
7. Citizenship
8. What languages other than English do you
ut
speak?
White
1
Single
X Native born
None
4 German
4 Negro
Married
Naturalized
1 Spanish
5 Scandinavian
I,
Other
Widowed
Non citizen
French
Polish
Divorced
Nationality
Italian
Other
Catholic Sister
e
9. Date of birth Oct 3, 1897 Place of birth Hayesvill O
Is Father a citizen
Yes
Birthplace of Father Perrypirli O. Mother Hayesville G.
of the United States?
No
F
10. General education (prior to entering nursing):
0
Did you graduate from high school X Yes If no, how many years of high school do you lack?
T
2 No
e
What college or university education did you have prior to entering nursing?
s
None or less
1 1 year;
2 2 years;
3 years;
Bachelor's
Master's
Ph.D.
than 1 year;
Degree;
Degree;
T
11. Nursing Education:
a. School of nursing from which
graduated Flown Hospital Jobedo
Chio
(Name)
Date of graduation august 3
(City)
(State)
1920
Length of course:
5 years;
3 years;
b. Undergraduate affiliations:
(Specify other)
Clinical
Hospital or Organization
City and State
specialty
No. months
(1)
(2)
(3)
c. Postgraduate clinical courses (Do not include academic work or employment)
Clinical
Inclusive
Hospital or Organization
City and State
specialty
dates
(1)
(2)
I
(3)
d. Academic study since graduation from School of Nursing:
Number of full time
Number of
13
College or University
Cleveland O
City and State
academic years
points
(1) Western Reserve
6
(3) (2) ashland College
ashland co
4
J
e. Check all degrees obtained
Bachelor's
5 Master's
Ph.D.
7 Certificate in Public Health
subsequent to entering training:
Degree;
Degree;
Nursing
f. In which major field was your academic study?
1
Institutional
2
Public Health
5
Non nursing (specify)
Psychology
Other (specify)
15
(OVER)

Page data

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Document data

ID: 2661311
Core: doc
Type: document

DTO data

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Document source extras

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Page context

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    "ocrText": "I\nFORM 1037\nREV. JULY 1941\nAMERICAN RED CROSS\nNURSING SERVICE\nDate\nAPPLICATION FOR ENROLLMENT\n(To be filled out in applicant's handwriting and each question\n1. Name of applicant in full mounth Thaum\nJ.\nIf married, give maiden name\nFarest Ruth gutheri\nE,\n2. Permanent address\nR. R# / Custlins Crawford ahio\n3. Probable address for one year 286 Cleveland ava \"ashland (ashland (County) ahio (State)\n(Street)\n(City)\n(Street)\n(City)\n(County)\n(State)\n4. Name and permanent address of nearest relative or friend residing in the United States:\nJohn R Laum Crestline O\nHusband\n(Name)\n(Address)\n(Relationship)\n5. Race\n6. Present Marital Status\n7. Citizenship\n8. What languages other than English do you\nut\nspeak?\nWhite\n1\nSingle\nX Native born\nNone\n4 German\n4 Negro\nMarried\nNaturalized\n1 Spanish\n5 Scandinavian\nI,\nOther\nWidowed\nNon citizen\nFrench\nPolish\nDivorced\nNationality\nItalian\nOther\nCatholic Sister\ne\n9. Date of birth Oct 3, 1897 Place of birth Hayesvill O\nIs Father a citizen\nYes\nBirthplace of Father Perrypirli O. Mother Hayesville G.\nof the United States?\nNo\nF\n10. General education (prior to entering nursing):\n0\nDid you graduate from high school X Yes If no, how many years of high school do you lack?\nT\n2 No\ne\nWhat college or university education did you have prior to entering nursing?\ns\nNone or less\n1 1 year;\n2 2 years;\n3 years;\nBachelor's\nMaster's\nPh.D.\nthan 1 year;\nDegree;\nDegree;\nT\n11. Nursing Education:\na. School of nursing from which\ngraduated Flown Hospital Jobedo\nChio\n(Name)\nDate of graduation august 3\n(City)\n(State)\n1920\nLength of course:\n5 years;\n3 years;\nb. Undergraduate affiliations:\n(Specify other)\nClinical\nHospital or Organization\nCity and State\nspecialty\nNo. months\n(1)\n(2)\n(3)\nc. Postgraduate clinical courses (Do not include academic work or employment)\nClinical\nInclusive\nHospital or Organization\nCity and State\nspecialty\ndates\n(1)\n(2)\nI\n(3)\nd. Academic study since graduation from School of Nursing:\nNumber of full time\nNumber of\n13\nCollege or University\nCleveland O\nCity and State\nacademic years\npoints\n(1) Western Reserve\n6\n(3) (2) ashland College\nashland co\n4\nJ\ne. Check all degrees obtained\nBachelor's\n5 Master's\nPh.D.\n7 Certificate in Public Health\nsubsequent to entering training:\nDegree;\nDegree;\nNursing\nf. In which major field was your academic study?\n1\nInstitutional\n2\nPublic Health\n5\nNon nursing (specify)\nPsychology\nOther (specify)\n15\n(OVER)"
}

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